The Remarkable Staying Power of “Death Panels”

David M. Frankford is professor of law at the Rutgers Law School; professor at the Rutgers Institute for Health, Health Care Policy, and Aging Research in New Brunswick; faculty director at Camden of Rutgers Center for State Health Policy; and member of the Department of Public Policy and Administration in Camden. He is also the editor of Behind the Jargon, a special section of the Journal of Health Politics, Policy and Law. His primary current research interest concerns the reconstitution of professionalism as the normative integration of professions and community. His work also focuses on the interactions between health services research, health care politics and policy, and the institutions of professions and professionalism. He has also published routinely on issues in health care financing. With Sara Rosenbaum, he is the coauthor of the second edition of Law and the American Health Care System (2012).

Abstract

Sarah Palin's phrase “death panels” derailed proposed provisions of the Affordable Care Act (ACA) to pay physicians for end-of-life discussions with patients, a policy designed to make dying more humane, something all Americans desire. Even now, “death panels” has truth-value for approximately half of Americans and is used to paint ACA components as threatening to “pull the plug on Grandma.” How can this be? To some, the death panels claim is simply a lie, an improvised explosive device hurled against any ACA provision. To others, the phrase's power stems from the public's lack of a common vocabulary to discuss end-of-life care. “Death panels,” however, taps into many Americans' fear of government involvement, that government's purchasing end-of-life discussions as commodities necessitates accountability and cost control. Standardization and reduction of humanity follows, something Americans already experience routinely in their health care system. Expert jargon, compelling among experts themselves, doesn't evoke people's images of chats with Marcus Welby. The jargon is unintelligible, off-putting. When that jargon enters the nonjargonized world, it mixes with common fears, extant experience of dehumanization and reduction, and awareness that someone's plug is getting pulled all the time. “Death panels” cannot be dismissed as delusional, but neither can it help fulfill Americans' aspirations for a humane last voyage.